Chronic Vertigo

Chronic Vertigo Overview

Chronic vertigo describes several sensations, such as spinning (vertigo), light-headedness or near fainting (presyncope), and loss of balance or unsteadiness (disequilibrium) that persist over time.

Vertigo is just one form of dizziness and is usually described as the sensation of movement, especially spinning sensations. When dizziness is described this way we refer to it as vertigo. Vertigo can be divided into two broad categories:

• Peripheral vertigo is related to the inner ear.
• Central vertigo is related to the central nervous system regions (that is, the brain) that receive and process inner ear signals.

Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. BPPV is a type of peripheral vertigo and is the most common disorder of the vestibular system, which is responsible for balance and sense of spatial orientation. BPPV occurs when small pieces of calcium carbonate called otoconia break free from the gravity-sensing structures of the inner ear and move by the effect of gravity (the crystals are heavy and sink) within the fluid-filled tubes in the inner ear called semicircular canals. As the crystals move within the canal, they set off the sensors causing vertigo.

Near-syncope

Near-syncope is another form of dizziness that is due to transient underperfusion of the brain by blood flow. This is basically the same mechanism that leads to fainting (syncope). When it is a little milder, the person may just feel lightheaded, but not actually pass out.

Imbalance or Disequilibrium

Imbalance or disequilibrium refers to a sensation of dizziness in which a person feels unsteady and unsure of balance. There is not a sensation of near fainting, nor is there a spinning sensation, but rather a feeling like the person might fall or lose balance. This sensation is usually present when standing or walking and not when sitting down or lying down. There are many possible causes for this symptom and, if it persists over time, consultation with a neurologist may be necessary.

Central vertigo may have other symptoms such as:

• Difficulty swallowing
• Double vision
• Eye movement problems
• Facial paralysis
• Slurred speech
• Numbness on only one side of the body or face

Contact your doctor if you have symptoms of vertigo. Call 9-1-1 if you suddenly experience severe dizziness accompanied by other symptoms, such as double vision, slurred speech, or loss of coordination.

Chronic Vertigo Treatments

Some forms of vertigo get better without treatment.

The canalith repositioning procedure, or Epley maneuver, can improve symptoms resulting from benign paroxysmal positional vertigo (BPPV), usually on the same day.

Other forms of peripheral vertigo such as vestibular neuritis may require vestibular rehabilitation physical therapy.

Meniere’s disease is often treated with low sodium diet and diuretics, and sometimes with other approaches which occasionally include surgery.

Vestibular migraine is thought to be a neurotransmitter or ion channel disorder of the brain and can cause recurrent vertigo that can sometimes be disabling. It can sometimes be managed by dietary and lifestyle changes, but many times requires medications to treat the underlying cause.

There are many causes of dizziness, each with its own treatment. Other conditions we treat include:

• Superior canal dehiscence
• Chronic subjective dizziness and phobic postural vertigo
• Bilateral peripheral vestibular loss (Dandy’s syndrome)
• Mal de debarquement
• Perilymphatic fistula
• Isolated utriculosaccular functional loss
• Many others

Our program can manage all forms of chronic vertigo, whether vestibular (inner ear causes, vestibular migraine, central vertigo, etc.), hemodynamic (e.g., low blood pressure or autonomic including POTS), anxiety-related, or whether the dizziness is due to disequilibrium caused by any of a variety of disorders.